局部枸橼酸钠与普通肝素在连续性静静脉血液滤过中抗凝效果的系统评价  

The Anticoagulant Effects of Local Sodium Citrate versus Unfractionated Heparin in Continuous Veno-venous Hemofiltration: A Systematic Analysis

作　　者：杜兴[1] 马成[2] 杜娟[3] 

机构地区：[1]重庆医科大学第一临床学院,重庆400016 [2]湖北中医药大学临床学院,湖北武汉430065 [3]湖北医药学院附属人民医院重症医学科,湖北十堰442000

出　　处：《湖北医药学院学报》2014年第5期452-457,共6页Journal of Hubei University of Medicine

摘　　要：目的：系统评价局部枸橼酸盐抗凝在ICU急性肾损伤患者进行连续性静静脉血液滤过（CVVH）过程中的有效性和安全性。方法：计算机检索Pub Med、EMBASE、CNKI、VIP、CBM和Cochrane图书馆,纳入比较枸橼酸盐与普通肝素在CVVH过程中抗凝效果的随机对照试验（RCT）,检索日期截止至2014年4月。按照纳入排除标准选择试验并评价其质量,而后提取有效数据进行Meta分析。结果：共纳入4个RCTs,包括258例患者。Meta分析显示：局部枸橼酸钠抗凝能降低出血事件的发生率（RR=0.25,95%CI=0.09-0.68,P=0.006）,且具有较长的滤器使用寿命（MD=14.36,95%CI=1.11-27.61,P=0.03）,但代谢性碱中毒（RR=0.89,95%CI=0.16-4.96,P=0.90）和低血钙的发生（RR=4.44,95%CI=0.76-25.83,P=0.10）均无统计学差异。结论：基于当前临床证据,在CVVH过程中,局部枸橼酸钠抗凝能减少出血事件的发生,且滤器的使用寿命较长,更适应于需要进行CVVH治疗但具有较高出血风险的患者。Objective To assess the efficacy and safety of local citrate anticoagulation in the process of continuous veno-venous hemofiltration（ CVVH） for acute kidney injury（ AKI） patients in ICU. Methods We searched the Pubmed,EMBASE,CNKI,VIP,CBM,and Cochrane library for randomized controlled trials（ RCTs） that comparing the anticoagulate effects of local citrate and unfractionated heparin in CVVH up to April 2014. The RCTs were selected and assessed based on the inclusion and exclusion criteria,then the data was extracted for meta-analysis. Results Finally 4 RCTs with 258 patients met the inclusion criteria. The meta-analysis showed that local sodium citrate obviously decreased the incidence of bleeding（ RR= 0. 25,95% CI = 0. 09 - 0. 68,P = 0. 006） and prolonged the service life of filter（ MD = 14. 36,95% CI = 1. 11 - 27. 61,P= 0. 03）,but the incidence of metabolic alkalosis（ RR = 0. 89,95% CI = 0. 16 - 4. 96,P = 0. 90） and hypocalcemia（ RR =4. 44,95% CI = 0. 76 - 25. 83,P = 0. 10） was no significant differences between two groups. Conclusion Based on the current clinical evidence,local citrate may be more suitable for the patients with higher risk of bleeding and the treatment of CVVH,because of its advantages of reducing the rate of hemorrhage and extending the service life of filter.

关 键 词：枸橼酸盐 肝素 抗凝 连续性静静脉血液滤过 系统评价 

分 类 号：R692.5[医药卫生—泌尿科学]